Private Physiotherapy

Experts in Spine, Knee, Shoulder,

Elbow and Joint Care

020 8907 7666

Official and Exclusive Physiotherapy / Medical providers to the England Beach Football Team.

Foundation of International Musculoskeletal Medicine

Awarded 5 STARS for Clinical Excellence & Academic Research.

Our employees are regularly tested for COVID-19. Helping us keep you safe.

COVID-19 Pandemic Physiotherapy Treatment Consent Form

First Name

Surname

Phone Number

I knowingly and willingly consent to have face to face Physiotherapy Treatment completed during the COVID-19 pandemic. I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it, and who does not, given the current limits in virus testing. I have been made aware that under the current pandemic, Physiotherapy care is primarily conducted via online Telehealth appointments, but that a face to face consultation may take place when clinically necessary and a risk assessment has been undertaken. I understand that the during my appointment, the Physiotherapist will be wearing Personal Protective Equipment (PPE), as set by Public Health authorities and that I have been advised to wear a face covering whilst within the clinic. I confirm that I have not had any of the following symptoms of COVID-19 listed below within the last 14 days or knowingly been in contact with anyone with these symptoms:.

Fever (Temperature of above 38.9) Shortness of breath Loss of sense of taste or smell Dry cough Runny nose Sore throat

Have you or anyone you live with been identified as extremely vulnerable to Covid-19?

Yes No

Initial to sign

I am aware that there is an increased risk of coronavirus infection, if I choose to attend a face to face consultation, despite all precautions being taken. Please ask your physiotherapist before signing this form if you have any questions about this information.

I confirm I have read and understand the content of this consent form, including that there is a risk of coronavirus infection in attending a face to face consultation; I confirm that I am willing to accept that risk and any consequences thereof; I agree to undertake a face to face assessment despite this risk.

First Name

Surname

Initial to sign

Date

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Meet Our Specialists
Discalmer

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Meet Our Specialists
Discalmer

020 8907 7666
askaphysio@anatomie.co.uk

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